A new surgical
technique could allow
surgeons to perform
a radical hysterectomy in
women with early-stage cervical cancer
– with fewer complications, reduced
morbidity, and a lower risk of local
tumor recurrence than current surgical
methods, according to an article published
in The Lancet Oncology.
The technique, called total mesometrial
resection, is a modified version of
the traditional radical hysterectomy and
involves more accurate, anatomically
based resection of the cancer to prevent
damage to the pelvic autonomic nervous
system and to minimize surgical trauma.

For over 100 years, radical hysterectomy
has been the standard surgical
treatment for early-stage cervical cancer.
However, the procedure has a relatively
high rate of tumor recurrence and many
women experience postoperative bladder
and bowel dysfunction because
of damage to the autonomic nerve
system. In addition, postoperative radiotherapy
– given as part of standard
treatment – can have considerable unpleasant
side effects.

Current surgical practice is to remove
the pelvic tissue adjacent to the tumor
along with the cervix because of the
risk of it harboring cervical cancer.
However, it has been suggested that
local tumor spread may be restricted to
the Müllerian compartment (fallopian
tubes, uterus, and proximal, middle
vagina and their embryologically defined mesotissues) for relatively long
phases in its natural course, and that
the removal of the complete Müllerian
compartment in early-stage disease
could improve local tumor control while
reducing surgery-associated morbidity.

To improve on traditional radical
hysterectomy and to show that the early
stages of tumor growth are confined to
the Müllerian compartment, Michael
Höckel and colleagues assessed the
effectiveness of total mesometrial resection
without radiotherapy in 212
women with early-stage cervical cancer
between 1999 and 2008 at the University
of Leipzig in Germany. In this
study, they report the histopathological
tumor stages, resection margins, local
recurrence, surgical morbidity, and
five-year outcomes of these women.

Overall, findings showed recurrence-free
survival of 94 percent and five-year
survival of 96 percent, with low treatment-related disease. At a median
follow-up of 41 months, only 10 women
had a recurrence of their cancer.

The authors state, “Based on historical
controls, total mesometrial
resection without adjuvant radiation
has the potential to improve survival
by 15 to 20 percent.” They conclude
by calling for further evaluation of
the technique with multi-institutional
controlled trials.

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This article was printed from copingmag.com and was originally published in Coping® with Cancer magazine,
July/August
2009.